Chapter 44 Parkinsons D.docx

Chapter 44 Parkinsons D.docx - Chapter 44 Management of...

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Chapter 44: Management of Patients with Nervous System Disorder Parkinson Disease (Lewis p1432) - PD: chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest, and gait disturbance. - Prevalence of PD is about 160 per 100,000. - The diagnosis of PD increases with age, with the condition affecting about 2% of people over 60 years old. - 15% of those diagnosed with PD are less than 50 years old. - PD is more common in men by a ratio of 3:2 Pathophysiology: - Degeneration of the DA-producing neurons in the substantia nigra of the midbrain which disrupts the normal balance between DA and acetylcholine (ACh) in the basal ganglia. - DA (dopamine): Neurotransmitter essential for normal functioning of the extrapyramidal motor system, including control of posture, support, and voluntary motion. - Manifestations of PD do not occur until 80% of neurons in the substantia nigra are lost. - Lewy bodies, unusual clumps of protein, are found in the brains of patients with PD. It is not known what causes these bodies to form, but their presence indicates abnormal functioning of the brain. Causes: - Exact cause is unknown - Environmental and genetic factors - Exposure to toxins or certain viruses may trigger PD. - Parkinsonism-like symptoms have occurred after intoxication with a variety of chemicals, including carbon monoxide and manganese (among copper miners) and the product of meperidine analog synthesis, MPTP. - Drug-induced parkinsonism can follow therapy with metoclopramide (Reglan), reserpine (Serpasil), methyldopa (Aldomet), lithium, haloperidol (Haldol), and chlorpromazine (Thorazine). - Parkinsonism can be seen after the use of illicit drugs: amphetamine and methamphetamine. - Other causes: Hydrocephalus, MS, encephalitis, infections, stroke, tumor, Huntington’s disease, and trauma Genetic Link: Approximately 20% of PD patients have a family history of PD. Many autosomal dominant and recessive genes have been linked to familial PD. The most common genetic contributor to PD is the LRRK2 gene. Mutations in this gene also appear to have a role in sporadic, or noninherited, cases of PD. LRRK2 and mutations in another gene, α-synuclein (SNCA), have manifestations similar to those of the common, age-related PD. Other genes involved in familial PD are parkin (PARK2), DJ-1, and PINK1. Mutations in these genes are often associated with a younger age of onset and have additional manifestations than those typically seen with age-related PD. PINK1 mutations are related to a rare, early-onset form of PD Preventative measures Physical assessment Drug therapy Drug toxicity interventions Priority of care and management o Medical o Surgical
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Disease of basal ganglia characterized by o Slowing down in the initiation and execution of movement o ↑ muscle tone o Tremor at rest o Gait disturbance Associated with decreased levels of dopamine caused by destruction of cells in the substantia nigra in the basal
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  • Spring '17
  • Acevedo
  • Parkinson's, bradykinesia, o Tremor

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